June 1999 Volume 24, Number 2

Tinnitus day THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION "To promote relief, prevention, and the eventual cure of tinni tus for the benefit of present and future generations" Since 1971 Education -Advocacy - Research - Support In This Issue: Gaze-evoked Tinnitus 'Iteatment of Tinnitus and TMJ Dysfunction Perfusion of the Inner Ear Via Round Window Membrane The Tinnitus Research Consortium Tinnitus Prevention in Young People A Sound Pollution Solution Sound therapy - this is a relatively ............ "'"--" untapped lifestyle enhancer. You're providing yourself with a much healthi-er environment- a break from "sound pollution." It's a whole new way to relax and soothe your senses. The sounds of nature have a way or bringing you to a different place- a place where you'll revel in a great night's sleep; a place where your concentration can be heightened and a place where the stress of the day vanishes almost instant-ly. Simply turning on a Marsona Sound Conditioner from Ambient Shapes can bring these pleasing sounds and serenity to your life . You see, sound conditioning makes -... your surroundings as tranquil as a light spring rain or night time at a mountain lake. The limits are strictly where your mind can take you. Sound Conditioners from Ambient Shapes provide the stimulus, your body relaxes and your mind goes where it wants to be. Let yourself be taken away and let tranquility finally be a part of your life whether you're having difficulty sleeping, keeping on track while working at home or the office, surviving the unpleasantness of Tinnitus or trying to make it through your stressful day. This could be the simplest answer to your toughest problems. popular units offer you the enough to be taken with you when travelling. ORDER TOLL FREE NOW r----------, Major credit card holders please call toll CXder Item # I MA1 280 for lhe 1-klme/Office Soond Condiooner- $149.00 I I # TSC350 Combination Soufll Cofllitioner/Travel Almm I ClJck - $99.00 # TSC330 Model Sound O:roiUoner -1 $79.00 (FREE Shippklg & handling io USA). NC residents 1 add sales tax. one (1) year warranty I -llirty (30) clay mooey ooc:k guarantee. I I I I 800-438-2244 I I Toll Free Fax: 8001872-2005 www.ambientshapes.com I I Local: 828!.324-5222 fax: 828!.327 -4634 I I I

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TSCI350 has inter!Ollional dlal voltage TSCC-350 Olmper model has a 12 volt DC auto rd Controllable LCD diSplay lighi PtiSh button operation Slide conlrols for tone and volume ITEM# TSC350 .. .. ... .. $9900 ALL MODELS: 30day urrondi1iooal guarantee One Year limttoo warranty Made in the USA Tinnitus Editorial and Advertising offices: American Tinnitus Association, P.O. Box 5, Porriand, OR 97207 S03/248998S, 800/6348978 http:f jwww.oto.org Executive Director & Editor: Gloria E. Reich, Ph.D. Associate Editor: Barbara Thbachnick Timuttts 7bday is published quarterly in March. June, September, and December. It is mailed to American Tinnitus Association donors and a selected list of tinnitus suffer-ers and professionals who treat tinnitus. Circulation is rotated to 80,000 annually. The Publisher reserves the righr to reject or edit any manuscript received for publication and 10 reject any advertisi ng deemed unsuit-able for nnmtts 7bday. Acceptance of adver-tising by Tinnitus 70day does nor constitute endorsement of the advertiser, its products or services. nor does Tinnitus Thday make any claims or guarantees as to the accuracy or validity of the advertiser's offer. The opinions expressed by comributors to Tinnitts 7bday are not necessarily those of the Publisher, editors, staff, or advertisers. American Tinnitus Association is a non-profit human health and welfare agency under 26 USC 501 (c)(3). Copyright 1999 by 1\merican Tinnitus Association. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form, or by any means, without the prior wrirten permission of the Publisher. ISSN: 0897-6368 Executive Director Gloria E. Reich, Ph. D., Portland, OR Board of Directors James 0. Chinnis, Jr., Ph. D., Manassas, VA Claude H. Grizzard, Sr., Atlanta, GA w. F. S. Hopmeicr, St. Louis, MO Gary P. Jacobson, Ph.D., Detroit, Ml Sidney Kleinman, Chicago, JL Paul Meade, Tigard, OR, Chairman Philip 0. Monon, Portland, OR Stephen Nagler, M.D., F.A.C.S. , Atlanta, GA Dan Puljes, New York, NY Aaron I. Osherow, Clayton, MO Susan Seidel, M.A., CCC-A, Thwson, MD Tim Sotos, Lenexa, KS Jack A. Vernon, Ph.D., Portland, OR Mcga11 Vidis, Chicago, JL Honorary Directors The Honorable Mark 0. Hatfield, U.S. Senate, Retired Tony Randall, New York, NY William Shatner, Los Angeles, CA Scientific Advisors RDnald G. Amedee, M.D., New Orleans, J..A RDbert E. Brummett, Ph.D., Portland, OR Jack D. Clemis, M.D., Chicago, l L Robert A. Dobie, M.D., San Antonio, TX John R. Emmett, M.D. , Memphis, TN Chris B. foster, M.D. , La Jolla, CA Barbara Goldstein, Ph.D., New York, NY John W. House, M.D., Los Angeles, CA Gary P. Jacobson, Ph.D., Detroit, Ml Pawel J. Jastreboff, Ph.D. , Atlanta, GA William H. Manin, Ph.D., Portland, OR Gale W. Miller, M.D., Cincinnati, OH J. Gail Neely, M.D., St. Louis, MO Robert E. Sandlin, Ph.D., El Cajon, CA Alexander J . Schleuning, 11, M. D., Portland, OR Abraham Shulman, M. D., Brooklyn, NY Mansfield Smith, M.D., San Jose, CA Robert Sweetow, Ph. D., San Francisco, CA Legal Counsel Henry C. Breithaupt Sroel Rives Boley Jones & Grey. Portland. OR The Journal of the American Tinnitus Association Volume 24 Number 2, June 1999 Tinnitus, ringing in the ears or head noises, is experienced by as many as 50 million Americans. Medical help is often sought by those who have it in a severe, stressful, or life-disrupting form. Table of Contents 9 Perfusion of the Inner Ear Via Round Window Membrane by John R. Emmett, M.D., FA.C.S. 11 Gaze-evoked Tinnitus by Richard Salvi, Ph.D., and Alan Lockwood, M.D. 13 Tinnitus Prevention in Young People: A Survey of Students in Hamburg by Michael Freitag (translated by Mimi Macht) 14 Thmporal Bone Organ Donations 15 The Tinnitus Research Consortium by James B. Snow, Jr., M.D., FA.C.S. 16 Announcements 17 Successf ul Treatment of Tinnitus in Patient s with TMJ Dysfunction by Ira M. Klemons, D.D.S., Ph.D. 18 Community Health Charities -Public Donations for Tinnitus 19 TinnitusSupport@Groups by Barbara Tabachnick 20 My Friend T by David Barber 26 1999 Calendar Regular Features 4 From the Editor by Gloria E. Reich, Ph.D. 5 Letters to the Editor 21 Questions and Answers by Jack A. Vernon, Ph.D. 24 Special Donors and Tributes Cover: sunflowel's' (watercolor), by Gail Wells-Hess, wells56@ibm.net ol' 800/ 776-4245. Represented by the Seattle Art Museum Rental Sales Gallery, Seattle, Washington. Posters, cards and original painting available. American Tinnius Association Tinnitus Today/June 1999 3 FROM THE EDITOR by Gloria E. Reich, Ph.D., Executive Director On September 5, 1999, the International Tinnitus Support Association will hold a meet-ing at Fitzwilliam College, Cambridge, UK. The meeting will run from 1-5 p.m. and will feature presentations from several international group representatives as well as my chairman's report and a general discussion. Part of the order of business will be to elect a new chairman who will serve until 2002 when the group meets again during the 7th International Tinnitus Seminar in Perth, Australia. There is no special registration required to attend the ITSA meeting and anyone with an interest in furthering tinnitus support or self-help, especially in countries that don't presently have such an association, is cordially invited to attend. I wish to thank all of you who have given so generously of your time and money during the years that ATA has grown to be the pre-eminent organization for tinnitus in the world. Most of the tinnitus organizations in countries worldwide have patterned themselves on the ATA example. These organizations have brought hope to mil-lions of people through their caring and sharing of knowledge. Much has been learned about tin-nitus during these two decades and it is very appropriate at this point to acknowledge the fine research projects that we, and others, have fund-ed during the last 20 years. Finally, there seems to be a glimmer of ~ light at the end of the tunnel and I'm hopeful that the next ~ decade will truly bring relief for many from the incessant sounds of tinnitus. Your help is still needed, however. ATA research is funded primarily from your "restricted to research" dona-tions over and above your annual membership contribution. 4 Tinnitus 7bday/ June 1999 American Tinnitus Association Research that ATA has seeded has brought new ideas to the hearing research field. Those new ideas have generated more effective treat-ments for tinnitus and sdentific inquiries that were not even thought of in the 1970s. We've seen patients helped through better diagnosis because there is now a large data base that pro-vides information for the primary physician as wen as for the hearing specialist. This data base, called the Tinnitus Data Registry, began at the Oregon Hearing Research Center and is now to be utilized and supplemented on a nationwide basis through the Veterans Administration Hospitals. Masl<ing, a technique developed by Dr. Jack Vernon and colleagues, has provided a basis for helping patients for more than 20 years. It also was the forerunner of the very suc-cessful procedure known as Tinnitus Retraining Therapy. Sounds are employed in both of these treatments: masking provides instant relief to those who find the sound an acceptable substi-tute for their inner noise; TRT employs a similar sound, but more quietly so that over time the brain learns to ignore both it and one's own internal sound. ATA has supported the Tinnitus Data Registry, Dr. Vernon's early work about masking, and Dr. Pawel Jastreboffs later studies about TRT. ATA has also supported studies about various psychological interventions. It has been observed that often a combination of therapies will achieve much more relief than a single procedure. Some of these involve stress relief through behavior modification training, cogni-tive therapy, biofeedback, acupuncture, relax-ation therapy or a myriad of other mental and physical exercises. Another approach has been the use of drugs to alleviate tinnitus. People who have been deprived of sleep by their tinnitus are often grateful and relieved to have their physi-cians find a drug that can help them rest quiet-ly. In rare cases, surgery for the treatment of some other related problem provides help for the tinnitus as well. More recently, ATA and other funding organizations have supported basic research designed to identify the actual causes and mech-anisms of tinnitus. The most encouraging of these studies have involved the use of sophisti-cated imaging techniques that can show sites of activity in the brain when tinnitus is either pre-Letters to the Editor From time to time, we include letters from our members about their experiences with "non-traditional" treatments. We do so in the hope that the information offered might be helpful. Please read these anecdotal reports carefully, consult with your physician or medical advisor, and decide for yourself if a given treatment might be right for you. As always, the opinions expressed are strictly those of the letter writers and do not reflect an opinion or endorsement by ATA. ,have noticed improvements in tinnitus symptoms since I began adding vitamin supplements to my daily diet. They also seem to reduce my sensitivity to loud sounds and the sensation of "fullness'' in my ears. After about a week of taking a 600 mg of magnesium, I noticed a difference in the tonal quality of my tinnitus which I have had for 37 years. The ringing is more tolerable and subdued now, less "metallic" in quality. I still have periods of increase especially when I lie down, and peri-ods of near absence right after my morning shower, but overall improvement has occurred. Ed Edwards, PO. Box 971, Warsaw, MO 65355 FROM THE EDITOR (continued) sent or absent. Where tinnitus used to be the exclusive property of the hearing profession, it has now become an area of interest for psycholo-gists, neurologists, dentists, and others who have found interesting areas of overlapping activity. Dipping into these areas so briefly, I want to remind you that Tinnitus 'Ibday regularly pro-vides articles with in-depth coverage about treat-ment for tinnitus. You may also utilize ATA's bibliography service to inform yourself of the many ways tinnitus can be helped. Do you want to help tinnitus research direct-ly? All you need do is complete the survey in the middle of this issue. The information that is collected will help direct the course of research projects that are now being planned. This is your chance to make a difference. II As most of your readers know, Dr. Vernon donates every Wednesday of the year to receiving telephone calls from those of us around the world who have tinnitus. Over the years he has helped and given hope to thou-sands of people. After one recent conversation with Dr. Vernon, I offered to pay him for the consultation, but he refused saying this was one way he gives something back to humanity. Thus, I urge all others who are being helped by Dr. Vernon and those who have been helped in the past to make a donation to the ATA in his honor. It would be one way of expressing appre-ciation to him for his unselfish work. Enclosed is my check. Perhaps we can estab-lish a Jack Vernon Honor Fund which can be used to further tinnitus research. I am sure that that is something Dr. Vernon would endorse. Paul Guyton, 100 South Georgia Ave., Mobile, AL 36604, 334/438-1992 Editor's note: ATA's 'Ihbute Fund was established for just such a purpose. Contributions that are made to honor special individuals can be designat-ed specifically for tinnitus research. And yes, Jack approves of this very much! (continued) Advertisement Hearing Loss? Learn Lip Reading Compensate for noise, distortion & tinnitus with the I See Whnt You Say program Self-Help Video & Manual "Instruction and practice are imaginative, easy to follow and enjoyable." Journal ~ U Help lor Hard of H8811ng Peop/8 Send Check or Money Order Credit Card Orders $49.00 +$4.00 S&H (Calif. res. $3.55 tax} 800-549-1540 Hearing Visions ~ ~ "a 1 P.O. Box 16040 <:i'.r. ~ ~ jl San Luis Obispo, CA 93406 Q ) _ , ~ www.lipreading.com i9. 1 - -- T ~ American Tinnitus Association Tinnitus Tbday/ June 1999 5 Letters to the Editor (continued) The December issue of Tinnitus Today, which included Dr. Nagler's article on Ginkgo biloba, was of particular interest to me. I began using Ginkgold in 1992, and found it to be most helpful in suppressing the mild tinnitus in my left ear. In 1996, I started to develop the nosebleeds mentioned in Nagler's article. I have not found ENT specialists to be helpful or knowledgeable about tinnitus, so I didn't consult with my physician when the nosebleeds began. On a hunch, I stopped using Ginkgold in February of 1997. It was probably several months before the nosebleeds ceased entirely. A year later, my tinnitus was noticeably worse. In addition, I began to have sudden, slight episodes of imbalance. Frightened by the progression of my symptoms, I tried Phospholoba, another ginkgo product. But the nosebleeds resumed immediately, so I gave that up after a six-week trial. In October of 1998, I visited a chiropractor for a mild recurring neck injury. The chiroprac-tor prescribed Osteomax, a calcium supplement (500 mg calcium, 200 mg magnesium, 200 IU vitamin D, 100 mg L Lysine- one tablet daily). While I am pleased to report that my neck is now fine, I am even happier to say that Osteomax seems to be having a mitigating effect on my tinnitus. The relief became noticeable within two weeks ofbeginning the supplement. It is not as effective as Ginkgold was but there is enough of a change in my condition to warrant its continued use. Sometimes I hear no tinnitus at all; other times I hear it in both ears. While two months is admittedly too short a period from which to draw blanket conclusions, I hope this information will be of help to some ofyour readers. The address for the manufacturer of Osteomax is: Nutraceutics Corporation, Deerfield Beach, Florida 33441. Valerie Foley, New York, NY 6 Tinnitus Tbday/ June 1999 American Tinnitus Association ,had tried many prescriptions for my tinnitus but they did no good. Then a friend recom-mended that I try the herb Ginkgo biloba. I started to use Sundown Vitamins' ginkgo, standardized extract 6% terpene lactones, 120 mg. As long as I take at least two per day, it stops the ringing in my ears. What a relie1 Wayne Livingston, 292 East Garden Ave., Salt Lake City, UT 84115 I'm a musician, so the reasons for my mild case of tinnitus might seem obvious. However, the truth is that I don't attend loud concerts or play loud music. So how did I get tinnitus? During a rather desperate point in my life three years ago, I chose to take a telemarketing job. I had reservations about wearing head-phones all day, but I thought I could bear it until I found a better job. The headsets we had to wear were made so that we not only heard the person on the other end of the line, but we also heard our own amplified voices through the headphones. Th make matters worse, if we had a caller whose voice was especially faint, we had to turn up the volume to hear the customer which made our voices louder too! I tolerated this until my ears were physically sore. Eventu-ally I spoke with management and demanded that something be done. I was fortunate that they let me train for another position. Sleeping is now often difficult because I hear a hiss I can't turn off. During the day, my ears get tired easily. I have to pace myself and take frequent breaks to keep from getting headaches. I have contacted the headset manufacturer (Plantronics) but they do not believe that some-thing they make - and that was approved by OSHA - could be harmful. I hope to continue spreading the word to the audio equipment manufacturers so they can make their products safer. And I hope that people will learn that our hearing so often depends on the choices we make. Jeremy J. dePrisco, 717/ 657-0611, jdeprisco@paonline. com Letters to the Editor (continued) I am an ATA member, and appreciated your excellent article, "Sound Sensitivity," in the September 1998 issue. A resource you didn't mention was the hyperacusis listserv, a means for on-line communicating with people who are interested in the topic. To subscribe, send an e-mail message to majordomo@utdallas.edu Write: subscribe hyperacusis yourname It should take your e-mail address. It is run by the University of 'Texas at Dallas where there is a tinnitus/ hyperacusis clinic at the Callier Center for Communication Disorders (214/ 905-3027). I am a teacher in another area, but was treated at the clinic with excellent results. Susan Chizeck, Ph.D., Director of Internships, U of 'Iexas at Dallas, MS GR 2. 6, Richardson, TX 75080-0688, 9721883-2354, fax 972/ 883-2440 I feel for Dr. Vernon's four patients who suf-fered hearing loss and tinnitus as a result of air bag deployments in otherwise minor traf-fic accidents. I have tinnitus as a result of noise exposure from a single rock concert. My biggest fear now is being exposed to another loud noise. And the biggest risk, I feel, is from an air bag deployment. It is enough of a fear that I have decided to not purchase a new vehicle. Dr. Vernon's letter to NHTSA [see the Dec. 1998 Tinnitus Tbday] in which he called for on-off air bag switches is well intended. But I feel that a slightly different solution is needed. First of all, the air bag is activated by sensors designed to activate when a certain speed is exceeded. The problem is that NHTSA has set the acceleration level at which the air bag must deploy too low, a level at which the car's occu-pants are not at risk to severe injury. That is why an air bag can deploy in a 12 mph collision in a parking lot. I believe that NHTSA needs to significantly raise the impact speed threshold for air bag deployment. It is arguable as to whether or not air bags cause more harm than they prevent. Given this, I feel that individuals should not be forced to use them. Stephen P Maxin, 503 Penny Lane, Cockeysville, MD 21030-2757 I don't mean to beat a dead horse but it really irks me when people, especially trained professionals in the hearing field, pronounce tinnitus with a soft vowel sound on the second "I" instead of the long "I" (as in eye). I think it is important to consider the fact that both Dorland's Medical Dictionary and Taber's Cyclopedic Medical Dictionary list the long "I" pronunciation as the first, or most prominent one. (In fact, my 1981 edition of Thber's only lists the long vowel form). Which pronunciation best describes the condition of ringing in the ears: a soft word (tin-it-us), or a sharp one (tin-night-us) that hits the mark? Those of us with this persistent and nagging problem would agree that it's not a matter to be diminished by description. Please - especially you professionals - call it like it is! Brian R. Lux, PO. Box 363, Pollock Pines, CA 95726-0363, 530/ 642-0628 Will you please correct the pronunciation of this medical condition which is not an infection or inflammation of anything, as the suffix "itis" indicates? You must teach every-one to say tin' i-tus, not tin-night'-us, as on the new poster. This really bugs me! Marion J. Nims, 4629 194th St. S ~ #311, Lynnwood, WA 98036 Editor's Note: When ATA was founded in 19 71, the founders considered the pronunciation of the word. The director at that time opted for Dorland's Medical Dictionary's preferred pronunciation -tin-night' -us. Both pronunciations (tin-night'-us and tin'-i-tus) are used and acceptable. American Tinnitus Association Tinnitus 7bday/ J une 1999 7 Advertisement Free For 30 Days! The Quick R e l i e i ~ M Audio cassette orr CD Prrogram Clinically tested and proven to be effective. Now available direct to you - free! The Tinnitus Relief System (TRS) audio programs were developed over several years to make full use of an amazing recording technology, 3-0 Virtual Reality Sound by Visual Sound. This technology enhances the effectiveness of the TRS products by combining entertaining, soothing music and natural recordings with digitally mixed, sophisticated sound wave composites (not static white noise). This produces an exceptionally effective, phase-canceling and masking effect. This dual attack on tinnitus symptoms provides a level of reli ef previously unavailable to tinnitus sufferers. Ask your ENT or audiologist about the TRS programs. 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In previous issues of Tinnitus Tbday a number of different treatment modalities for trou-blesome ear noises have been reviewed. These modalities include tinnitus masking, habituation training, and the treatment of tinnitus with various oral medications and electrostimulation. This article is not about a specific treat-ment (i.e., a drug), but rather it is intended to make the reader aware of a drug delivery system to the inner ear that has become the subject of increasing interest in research involving disor-ders of the ear, hearing, and balance. Any medkation, whether taken orally or intravenously, reaches its site of action via the bloodstream. Occasionally a particular medica-tion will have a certain predilection for a certain target organ, but generally speaking the medica-tion becomes evenly distributed throughout the body. For example, if a person is receiving an antibiotic for an ear infection, the level of the antibiotic in the patient's little finger is about the same level as found in the ear itself. Because of the real or potential side effects of many medica-tions, the dosage level has to be kept relatively low. The same problem is encountered in radia-tion therapy for certain malignant tumors. The dosage of the radiation has to be adjusted to prevent potential damage and subsequent side effects to structures and organs immediately adjacent to the tumor. In recent years, radio-active materials, commonly called seeds, have been directly placed into the tumor mass, there-by achieving a much higher level of radiation to the tumor mass while sparing the surrounding tissues of potential harmful effects of higher levels of radiation. In the last several years, there has been increasing interest in a similar treatment modali-ty to the inner ear. The ear is commonly divided into three anatomically different spaces. The outer ear is made up ofthe pinna (earlobe) and the external auditory canal (ear canal). The middle ear consists of the tympanic membrane (eardrum) and three ossicles (hearing bones). The inner ear consists of the cochlea (snail-shaped portion of the inner ear containing the hearing nerve) and the three semicircular (bal-ance) canals. The small thimble-sized space underneath the eardrum, called the middle ear, is separated from the inner ear, which is com-pletely encased in bone, by a small membrane called the round window membrane. The round window membrane lies at the end of a sma11 cave-like opening in the middle ear called the round window niche. The round window membrane is semi-permeable, which allows some fluids placed into the middle ear space to perfuse or, as our used to say, "seep," into the inner ear much hke coffee passing through a coffee filter. This fact allows for the introduction of drugs into the middle ear space that subsequently seep into the inner ear. This results in a higher therapeutic level of the medication in the inner ear fluids than could be achieved by giving the same medication orally or intravenously. This has led to a number of ongoing studies using a variety of medications (some of which could have toxic side effects to other organ systems when administered orally or intravenously) for the treatment of a variety of ear, hearing, and balance disorders. The procedure itself can be performed with the use of a topical anesthetic agent or under a general anesthetic. Critical to the success of a perfusion procedure is visualization of the round window niche and removal of any tissue that may be blocking the niche, which would pre-vent medica6on from coming into direct contact with the round window membrane. (The niche is covered by an outer layer of tissue in approxi-mately one-fourth of individuals.) This can .be achieved by a standard middle ear exploratiOn done through the ear canal whereby the con-tents of the middle ear can be inspected after folding back the eardrum. If the round windo.w niche is blocked, the tissue is removed exposmg the round window membrane, and the eardrum returned to its normal anatomical position. A small incision is made through the eardrum, and the middle ear space is filled with medica-tion. An alternate method, which can be done (continued ) American Tinnius Association Tinnitus 7bday/ June 1999 9 Perfusion of the Inner Ear (continued) under a topical anesthetic while the patient is awake, is done by making an incision through the eardrum directly over the round window thereby allowing visualization of the round win-dow niche and membrane. Once it is established of the drug have been found in the lower and upper turns of the hearing portion of the inner ear (cochlea) as well as in the balance portion (vestibule) after being left against the round window membrane for three hours1

that the round win-dow niche is not blocked, the medica-tion is injected into the middle ear space through the incision in the eardrum. In 1987 and 1991, Sakata, Iota, and their colleagues2

3 reported treating 61 Meniere's patients with perfu-sion through the round window with The incision in the eardrum typically heals in five to seven days. Most medicines are suspended in another solution, such as Hyaluron, which results in a vis-cous, or syrup-like, liquid that is intro-duced into the middle ear space. This helps maintain the medica-tion in the middle ear space, adjacent to the round window membrane. If the medication was not suspended in such a material, it could drain down the eustachian tube and into the back of the throat. The patient is then instructed to lie down with the operated ear up for three hours. Depending upon the medication used and the ear disease being treat-ed, the perfusion is usually done on a daily basis for several days. 2 mg of dexametha-sone. They received good results regarding control of vertigo and improvement of hear-ing. Parnes et al,4 have shown that anti-inflammatory steroids do not readily enter the inner ear fluids after oral or intra-venous administra-tion, even in larger- ___________ _. than-therapeutic In the past, the inner ear condition most commonly treated by perfusion of the inner ear via the round window membrane is Meniere's disease. Meniere's disease is due to an abnormal inner ear fluid build-up, the cause of which is not fully understood. This condition results in the symptoms of fullness in the ear, tinnitus, fluctuant hearing loss, and vertigo. Drugs that have been used in the past in the treatment of Meniere's disease using this treatment modality include gentamicin, streptomycin, and more recently dexamethasone or a dexamethasone/ streptomycin combination. There is good experimental evidence that dexamethasone readily passes through the round window membrane. Large quantities 10 Tinnitus 7bday/ J une 1999 American Tinnitus Association doses, but do get into the inner ear fluids and remain longer after round window perfusion. Shea, Jr., and Ge5 reported their results of dexamethasone perfusion of the inner ear plus intravenous dexamethasone for Meniere's dis-ease in their first 21 patients with a one-year follow-up. Their study showed improvement of hearing in 67.9%, reduction of fullness in 89.3%, a reduction oflow-tone tinnitus in 82.1 %, and relief from dizzy spells in 96.4%. The hearing was made only slightly worse in one patient (3.6%). In 1997 Shea, Jr.6 reported extremely encouraging results with the perfusion of dexam-ethasone and streptomycin for the treatment of Meniere's disease. It has been established that the round win-dow membrane is semi-permeable and allows passage of certain medications into the inner ear. This is a finding that has opened up a whole new area of research with regard to inner ear disor-ders. Hopefully in the foreseeable future, Tinnitus Tbday will be able to report to you the results of research that uses inner ear perfusion for the troublesome symptom of tinnitus. m Gaze-evoked Tinnitus by Richard Salvi, Ph.D., and Alan Lockwood, M.D. Patients who have undergone surgery to remove a tumor from their auditory I vestibular nerve sometimes develop an unusual form of tinnitus - gaze-evoked tinnitus. This type of tinnitus significantly increases in loudness and/ or pitch when the patients move their eyes to look to the side. When we were trying to locate individuals with gaze-evoked tinnitus to participate in our brain imaging studies, we thought we would be lucky to find five individuals with it. (It was thought to be a rare phenomenon since only a few case sh1dies have been reported in the scien-tific literature.) However, we have identified over 100 individuals in the United States who have gaze-evoked tinnitus. We were surprised by the large number of acoustic neuroma patients who have this kind of tinnitus. With our colleague, Robert Burkard, Ph.D., we are now analyzing the data from these tinnitus patients by comparing their PET brain images as they shift their eyes from looking straight ahead (when the tinnitus is low) to looking to the side (when the tinnitus is loud). So far, the results of our study have produced striking results. Specific regions of the brain are definitely activated, or tur ned on, by gaze-evoked tinnitus. Despite the fact that the patients lose hearing in the ear from which the tumors are removed, the subjects in our study report hearing the tin-nitus in their deaf ears. There is an inescapable conclusion that must be drawn from this obser-vation: the neural signal causing gaze-evoked tinnitus must be generated in the portion of the brain devoted to hearing and not in the deaf-ened inner ear. The brain likely "rewires" itself after the tumor is removed. We hypothesize that the aberrant, irregular neural connections that are formed lead to gaze-evoked tinnitus. Our research team has recently published a comprehensive PET study in which we've mapped the neural responses to pure tone sounds in normal subjects. We anticipate that the data from this investigation will serve as an important benchmark for comparing the normal human auditory system to the auditory system of patients with tinnitus and/ or hearing loss. The long-term goal of our study is to apply PET imaging technology to more standard forms of tinnitus. Ill Dr. Salvi is a researcher at the University of Buffalo's Center for Hearing and Deafness. Dr. Lockwood is a professor of neurology and a researcher at the University of Buffalo's Center for Positron Emission 7bmography. In 1998, Drs. Lockwood and Salvi received a $1.5 million grant from the National Institutes of Health for this five-year study. Richard Salvi, Ph.D., Hearing Research Lab, 215 Parker Hall, University of Buffalo, Buffalo, NY Phone: 716/829-2001, fax: 716/829-2980 E-mail: salvi@acsu.buffalo.edu Web site: http:! lwings.buffalo.edu/faculty/ research/ chd/ Perfusion of the Inner Ear (continued) References 1. Nomura, Y., Otological significance of the round window. Advances in Otorhinolaryngol 33: 67-72, 1994. 2. Sakata, E. , N. ltoh, A. ltoh et al., Comparative studies of the therapeutic effect of inner ear anesthesia and middle ear infusion of a steroid solution for Meniere's disease. Pract Otol (Kyoto) 80: 57-65, 1987. 3. Itoh, A. , E. Sakata, Treatment of vestibular disorders. Acta Otolaryngol Supple (Stockh) 481: 617-623, 1991. 4. Parnes, L.S., A.H. Sun, D.J . Freeman, Corticosteroid pharmacokinetics in the inner ear: A comparison of different drugs and routes of administration. Presentation to the Middl e Section of The American Laryngological, Rhinological and Otological Society. Dearborn, Michigan, January 21 , 1996. 5. Shea, J.J., X. Ge, Dexamethasone perfusion of the labyrinth plus intravenous dexamethasone for Meniere's disease. Otolaryng Clin of North Am 29: 353-358, 1996. 6. Shea, J.J., The role of dexamethasone or streptomycin perfusion in the treatment of Meniere's disease. Otolaryng Clin of North Am 30: 1051-1058, 1997. American Tinnius Association Tinnitus 'TOday/June 1999 11 Advertisement Dynamic Tinnitus MitigationTM The new Petroff Audio Technologies DTM-6 system incorporates the most advanced tinnitus suppression sound technology ever developed and can provide effective relief even for severe tinnitus sufferers. Fallowing one of the most intense research endeavors into the effects of sound on tinnitus suppression, Petroff Audio Technologies has developed an entirely new form of tinnitus masking sound called Dynamic Tinnitus Mitigation . Dynamic Tinnitus Mitigation (DTM) sound is incorporated exclusively in the new DTM-6 audio CD system and can provide remarkable relief of tinnitus symptoms. The DTM-6 consists of six specially recorded audio CDs and a Tinnitus Management Manual. The CDs are divided into three parts -DTM tinnitus suppression only, DTM tinnitus suppression plus natural relaxation sounds, and DTM tinnitus suppression plus natural relaxation sounds with gentle background music. The system demonstrates that major differences in effectiveness exist between DTM technology and conventional tinnitus suppression recordings. Dynamic Tinnitus lliti_.,. ,:._. ..

Testimonials on DTM Effectiveness The DTM technology effectively eliminates unwanted sounds produced below the tinnitus region, which to date has been the major fault with conventional masking technology. - Dr. Jack Vernon (world's foremost expert on tinnitus masking) I am writing you to voice my unrestrained enthusiasm for your DTM technology. I have to say I was completely overwhelmed by the sample you sent me. For years I have tried various devices in my practice. Personally, I suffer from tinnitus in both ears. Your system alerted me to the potential that exists with well-thought out solutions to this perplexing problem. - Dr. Steven M. Rouse (ear, nose, and throat physician) Ihave been a three-year sufferer of high-pitched tinnitus in both ears. The condition reached a climax about six months ago; at this time I could no longer achieve a good nights sleep (despite the use of a 'sound soother' from the Sharper Image), and would always awake feeHng slightly nauseated and dizzy with the condi-tion continuing throughout the day. Throughout this progression I have consulted among the best doctors in the field. With failed treat-ments ranging from Ginkgo biloba to having tubes surgically implanted, these fine physicians have come up empty with respect to tinnitus. My initial reaction once I turned on the first CD was one of utter amazement; I simply could not believe how low the volume level was while masking. I can vividly remember having to turn the CD player on and off again several times to make sure I still had tinnitus! With the DTM process, I no longer hear the ringing (unless I concentrate). For the first time I have been able to get through a day without Advi1 and I have even been known to attend a few movies (with earplugs, of course). Thanks again." - Paul Pedrazzi The DTM-6 sells for $199 + $9 S/ H (Calif. Res. add 8'/, % sales tax) and is sold with a 30-day unconditional money back guarantee plus a one-year factory warranty. For further information or to order, contact: Petroff Audio Technologies at 23507 Balmoral Lane, West Hills, CA 91307. Ph: (818) 716-6166 Fax: (818) 704-9976 E-mail: sales@tinnitushelp.com Web si te: www.tinnitushelp.com (Credit cards accepted) 12 Tinnitus 'TOday/June 1999 American Tinnitus Association Tinnitus Prevention in Young People: A Survey of Students in Hamburg by Michael Freitag (translated by Mimi Macht) Reprinted with permission from the Deutsch Tinnitus-Liga e. V's Tinnitus-Forum, August 1998 In order to initiate and promote various measures of tinnitus prevention, 1 spent seven months among teenagers and young adults researching the possibilities. The core of my research was a written survey administered to 584 male and female students aged 15 to 21. I personally conducted this survey in January and February of 1998 at a variety of high schools and trade schools. The results of my research follow. I was guided by two principles: to check on the necessity of tinnitus prevention geared specifically to young people, and to gain some insight into which particular measures of pre-vention should be addressed in the future. I chose schools for this survey so that a variety of young people could be included. Previously, only certain young people had been consulted in a study of this nature, namely sol-diers or university students. The young people in my survey had a choice, either to participate or to decline; the parents of minor children also were given the opportunity to refuse if they did not want their children to take part in the survey. The young people demonstrated an extraordinary interest in the subject manner, as witnessed by the return rate of the question-naire (97%). In addition, there were lively dis-cussions after the questionnaires were turned in, in which I answered their questions and informed the participants about the causes and possible prevention of tinnitus. The results of my research seem to confirm earlier estimates and concerns regarding the underlying causes of tinnitus: 1. Eighty-eight percent of the young people who replied had experienced noise in their ears, while 4% admitted to chronic noise, and 39% reported frequent episodes (more than three) of noise. The survey clearly confirms the assumption held by many experts that noise associated with young people's leisure activities is a causative factor in the origin of tinnitus. 2. Only a few of the young people with chronic tinnitus reported that they were impaired by the noise in their ears. 3. One cannot assume the need for preventive measures simply by the fact that certain young people are affected. Therefore, individual ques-tions in the survey sought answers: did some of the participants take preventive action, and did they have enough information to initiate suc-cessful measures to prevent chronic tinnitus? It turned out that only 8% of the young people made an attempt at protecting themselves from damage to their hearing, and that at least 60% of the young people, even those who had experienced acute tinnitus, had sought out no further information about causes and possible treatments. In my opinion, the large number of insuffi-ciently informed young people, the extremely small number ofyoung people who do protect themselves against loud music or noise, and the generally large incidence of tinnitus confirm the necessity for comprehensive preventive mea-sures geared specifically towards young people. After analyzing the data, and following my discussions with the young people, it became clear that information and education are, indeed, important aspects of preventive work. However, these are not sufficient to counteract the devel-opment of chronic tinnitus caused by excessive noise. Although 98% of the young people reported that undiminished hearing was highly important or at least significant to them, and at least 27% of the respondents were aware of the causes of tinnitus, only three of the young people acknowledged protecting themselves against harmful noise. It is my opinion that this situa-tion cannot simply be attributed to youthful lack of concern. As long as individually fitted and reusable plugs cost about $200 and are therefore a luxury item, only very few young people will use them to protect themselves successfully against harmful noise in discos and at concerts. Since I myself acquired chronic tinnitus at the age of 17 at a concert, I sympathize with these students, and I understand that they are not will-ing to use protective devices which interfere with the quality of the music. They feel particu-larly negative about using these expensive pro-tective devices at musical events, which are already quite expensive. (continued) American Tinnius Association Tinnirus TOday/ June 1999 13 Tinnitus Prevention in Young People (continued) In my opinion, the goal should be a legal limit of noise levels in discos, in WalkmanT .. devices, etc. Furthermore, there should be a reduction in the cost of protective plugs. The health insurance companies, that generally don't cover noise prevention devices used for recre-ation, as well as the manufacturers of these devices, could lead an initiative toward that end. Since 71% of the surveyed young people who had experienced noise in their ears attributed this noise particularly to loud music, it is appar-ent that we should concentrate on the noise levels that occur during recreational activities. We have very little information, and not much experience, with preventive measures directed primarily at young people. Th provide a basis for suggesting various methods of edu-cation in the field of tinnitus prevention, the young people were asked to rate specific preven-tive measures. The assumption was that a pro-posal would only be meaningful and efficient if it was acceptable to the young people. The following eight methods aimed at pre-vention were offered to the students. They rated them in their order of preference, and in some cases, their non-preference. The NIDCD's 'Temporal Bone Registry, estab-lished in 1992 to advance research on hearing and balance disorders, encourages people with tinnitus and other ear disease to become tempo-ral bone donors. They write: The temporal bone is the part of the skull that contains the structures of hearing and balance - the middle and inner ear (including the cochlea, ossicles, eardrum, semicircular canals, and parts of the cranial and vestibular nerves). Because of its inaccessible location inside the temporal bone, the inner ear can only be studied after death when the temporal bones are removed and processed for microscopic study. Knowledge gained from the study of temporal bones about how certain disorders, Iike tinnitus, affect the ear will ultimately improve the evaluation and treatment of hearing and balance disorders for others in the future. No one is too old or too young 14 Tinnirus 1bdayl June 1999 American Tinnitus Association Liked 1. an informational event at school 2. a detailed brochure about tinnitus 3. an Internet page 4. a short informational film, shown in movie theaters along with the commercials 5. a small informational card (credit card-sized) with instructions on what to do when a ring-ing in the ear suddenly occurs, and where to get help if it doesn't go away Disliked 1. a radio program about tinnitus 2. a flyer 3. telephone advice specifically aimed at young people The surprising evaluation of these preven-tive measures, and the diverse comments and creative suggestions which I was fortunate enough to gather through my interaction with the young people, led to one of the most signifi-cant conclusions of this entire survey: in order to carry on tinnitus prevention in young people, it is both necessary and sensible to include them in the initiation and the development of the pre-ventive measures. Cl to be a donor. Removal of the temporal bone Win not affect the donor's appearance and therefore will not affect funeral or burial arrangements. 'Temporal bones are collected at no cost to the donor's family or estate and will not delay the donation of other organs that the donor wished to donate. That Others May Hear (a short informational brochure) and The Gift of Hearing (a 16-page comprehensive brochure) explain in depth the process of temporal bone collection and the Registry's research goals. These materials are available free of charge. Voice: 800/822-1327, TrY: 888/561-3277 e-mail: tbregistry@meei.harvard.edu Web site: www. tbregistry. org NIDCD National Temporal Bone Registry Massachusetts Eye and Ear Infirmary 243 Charles St., Boston, MA 02114-3096 THE TINNITUS RESEARCH CONSORTIUM by James B. Snow, Jr., M.D., F.A.C.S. The Tinnitus Research Consortium was formed in the fall of 1998, and is supported by a philan-thropist who wants to accelerate progress in basic and clinical tinnitus research. The Consortium con-sists of 12 accomplished basic and clinical scien-tists some of whom have worked on the problem of t i ~ n i t u s before. Those who have not previously worked in tinnitus research are expected to apply a fresh perspective. Involving them is a way to bring additional cutting edge scientists to the problem. Those who have worked in tinnitus research lend experience and will help prevent the tendency to reinvent the wheel. The first meeting of the Consortium was held in November of 1998. The group unanimously agreed that the state of the science is sufficiently developed to make substantial research progress in tinnitus at this time. This opinion was based on discoveries and developments relevant to tinnitus that have occurred in the last 20 years but that have not been fully applied to tinnitus research. They include: 1) otoacoustic emissions, 2) the motility of the outer hair cells and its role in fre-quency selectivity and amplification, 3) the bio-physics of the conversion of sound energy to neural impulses, 4) the location of a multitude of disease genes and the cloning of many of them responsible for hearing impairment as well as development and maintenance of the auditory sys-tem, 5) the identification of molecular substrates of the auditory system, 6) the regeneration of the sensory cells in the auditory and vestibular sys-tems of birds and mammals, 7) the plasticity of the auditory system, 8) the organization of the central nervous system, 9) the ability to image central ner-vous system changes associated with tinnitus using positron emission tomography (PET) and function-al magnetic resonance imaging (fMRI), and 10) the chemical degeneration ofbrain cells caused by free radicals, glutamate cytotoxicity, ionic fluxes, etc. The group selected biophysics, molecular pathogenesis (origination and development of a disease), biochemical pathophysiology (functional changes that accompany a disease), diagnosis, physical suppression, and pharmacotherapy of tinnitus as the areas upon which to focus their research efforts. The group came to the conclusion that it must begin at the beginning by performing in-depth reviews of the literature in several critical areas. There is a need for a taxonomy - or classification guide - of tinnitus, diagnostic guidelines, a standardized patient questionnaire, and an annotated bibliography. Reviews of the lit-erature on electrical stimulation of the auditory system and the effects of salicylates on the central nervous system will be performed. Also, a manu-script of the review of clinical trials will be pro-duced and perhaps published. The Consortium wiU meet twice each year to brainstorm on new research strategies in tinnitus. The group agreed to delineate what is currently known about tinnitus and recommend approaches and strategies in tinnitus research. If members of the consortium could and would carry out the "The ... Consortium seeks to benefit the countless millions of tinnitus sufferers throughout the world by ... attracting new cutting-edge scientists to the problem .... H actual research proposed, that would be ideal. If not, they would be asked to identify scientists who could carry out the research. Written requests for applications will be developed and issued to the scientific community to accomplish the research. The requests for applications will be published electronically through the web sites of relevant sci-entific societies. The applications will be modeled after those used by the National Institutes of Health. Peer review would be performed by two or three members of the Consortium or by experts selected on the basis of the expertise needed for the topic of the proposed project. If members of the Consortium or their close colleagues are appli-cants, the review would be performed largely by individuals who are not Consortium members. Three years of support for each grant is anticipat-ed at up to $100,000 per year. Progress reports would be required every six months, and each year's support would be contingent on satisfactory progress. (Overhead costs will not be provided for projects supported through the Consortium.) Prompt publication of the results of the research in peer-reviewed journals will be encouraged. It is anticipated that two requests for applica-tions for clinical trials will be issued in the late spring of 1999. The Tinnitus Research Consortium seeks to benefit the countless millions of tinnitus sufferers (continued) Ame1ican Tinnius Association Tinnitus Tbdayl June 1999 15 Announcements lnterMed 199 - International Trade Show and Conference Date: June 21-23, 1999, Thronto, Canada North America's International Medical and Healthcare exhibition with delegates from 46 countries. Guest Speaker: Mr. Brian Wilson, United Kingdom's Minister of State for 'Itade and Industry Contact: Mark J. Palmer, 514/ 731-1015, fax 514/731-1645, e-mail: mpalmer@mpe.ca Cognitive Behavior Modification For Tinnitus: A Workshop for Patients and Friends Date: June 25-26, 1999, The University of Iowa, lowa City, Iowa Speakers include: Peter Wilson, Ph.D., Psychologist, Flinders University of S. Australia, Adelaide, Australia; Jane Henry, Ph.D., Psychologist, University of New South Wales, Sydney, Australia; RichardS. Tyler, Ph.D., Audiologist, University of Iowa Enrollment is limited and by pre-registration only Cost: $395 per person Contact: Cheryl Schlote, conference secretary, 319/ 384-9757, e-mail: cheryl-schlote@uiowa.edu 20th Anniversary meeting of the British Tinnitus Association -11Tinnitus Research Today" Date: September 4-5, 1999 Fitzwilliam College, Cambridge, UK Guest of Honor: Gloria E. Reich, Ph.D. Speakers include: Dr. Ross Coles, Dr. Carol Hackney, Dr. Ewart Davies, David Baguley, and Richard Hallam. Contact: BTA, Freepost NEA 3263, Sheffield, England, S1 lAY 3rd International Tinnitus Support Association meeting Date: September 5, 1999 Fitzwilliam College, Cambridge, UK 1-5 p.m., open to the public Contact: Gloria E. Reich, Ph.D., e-mail: gloria@ata.org 6th International Tinnitus Seminar Date: September 5-9, 1999 Cambridge, UK (See back cover of this issue for details) Seventh Annual Conference on the Management of the Tinnitus Patient Date: September 30-0ctober 1, 1999 The University of Iowa, Iowa City, Iowa For professionals and tinnitus patients. Guest of Honor: Jack Vernon, Ph.D. Speakers include: Michael Block, Ph.D.; Gloria Reich, Ph.D.; Meredith Eldridge, M.A.; Soly Erlandsson, Ph.D. psychiatrist; Anne Mette-Mohr, clinical psych-ologist; Paul Abbas, Ph.D.; Bruce Gantz, M.D.; Brian McCabe, M.D.; Rich Tyler, Ph.D.; David Young, M.A.; and Richard Smith, M.D. Contact: Rich JYler 319/ 356-2471, fax: 319/ 353-6739, rich-tyler@uiowa.edu, http: / / www.medicine. uiowa. edu/ otolaryngology /news/ news.html. THE TINNITUS RESEARCH CONSORTIUM (continued) throughout the world by clarifying the state of the knowledge in tinnitus research, attracting new cut-ting-edge scientists to the problem of tinnitus and devising promising tinnitus research approaches and strategies. Although I am largely retired, it is again a pleasure and a privilege to be involved in research with such a distinguished group of scien-tists, dedicated to accelerating progress in tinnitus. The members of the Tinnitus Research Consortium are: William E. Brownell, Ph.D., Department of Otolaryngology and Communicative Sciences, Baylor College of Medicine; Peter Dallos, Ph.D., Auditory Research Laboratory, Northwestern University; Robe1i A. Dobie, M.D., Department of Otolaryngology, University of Texas Health Sciences Center, San Antonio; Bruce J. Gantz, M.D., Department of Otolaryngology/Head and Neck Surgery, University of Iowa Hospitals and Clinics; 16 Tinnitus Thday! June 1999 American Tinnitus Association A. James Hudspeth, M.D., Ph.D., Howard Hughes Medical Institute, The Rockefeller University; Pawel J. Jastreboff, Ph.D., Sc.D., Emory Tinnitus and Hyperacusis Center, Emory University; M. Charles Liberman, Ph.D., Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary; Brenda L. Lonsbury-Martin, Ph.D., University of Miami Ear Institute, Department of Otolaryngology; Alfred L. Nuttall, Ph.D., Oregon Hearing Research Center, Oregon Health Sciences University; Allen F. Ryan, Ph.D., Division of Otolaryngology/ Head and Neck Surgery, University of California, San Diego; Leonard P. Rybak, M.D., Ph.D., Division of Otolaryngology, Department of Surgery, Southern Illinois University School of Medicine; and Phillip A. Wackym, M.D., Department of Otolaryngology and Communication Sciences, Medical College ofWisconsin. ri2 Dr. Snow is the former Director of the National Institute on Deafness and Other Communication Disorders, National Institutes of Health. Successful Treatment of Tinnitus in Patients with TMJ Dysfunction by Ira M. Klemons, D.D.S., Ph.D. The condition commonly referred to as "TMD" - tem-poromandibular joint disorder -is a complex dysfunction of muscles, ligaments, andjoints in the head, face, and neck. (The temporomandibular joint, or "TMJ," is the joint in front of the ear which allows us to speak, chew, swal1ow, kiss, smile, and exhibit normal facial expressions.) TMD is typically caused by injuries that result from falls, automobile acci-dents, trauma at birth, etc. It is very common for the onset of symptoms to be delayed for months or years. The delay of onset occurs, in part, because these tissues progressively degenerate. Close to half of the patients who have TMJ dysfunction have tinnitus as one of their symp-toms, and in these patients, success rates in eliminating these sounds approach 90%. Recent research has found that TMD therapy improves tinnitus in 46-96% of patients who have TMD and coexisting tinnitus. A survey of patients taken two years after TMD therapy suggests that improve-ment is sustained over time. The diagnosis of TMD requires evaluation by a dentist or physician with advanced training and experience in treating head and facial pain. Diagnosis begins by taking a detailed history of the patient's (sometimes extensive) list of com-plaints. Symptoms can include headaches; pain in the face, eye, neck, or ear; blurred vision that comes and goes; hearing loss that comes and ATTENTION ATA MEMBERS Please include your "zip+ 4" zip codes when you write to us. Those four extra numbers save us a considerable amount of money on postage. And since they speed up mail deliv-ery, they will help get Tinnitus Tbday to you faster. Thank you! goes; frequent sore throats; dizziness; ringing in the ears; pressure or blocked sensation in the ears; difficulty swallowing; burning tongue; and tingling or numb sensations of the arms and hands. A physical examination of the muscles of the head, face, neck, and shoulders is done using manual palpation to rule out "trigger points" and muscle spasms that can transfer pain to other areas. Range of motion tests, x-rays, sonograms, and painless EMG's can also help in reaching an accurate diagnosis. Treatment commonly employs painless pro-cedures which help stimulate muscles and joints to function normally, decrease spasm, remove toxic waste products, and increase blood flow and nutrition to the affected areas. Therapies such as low current electric stimulation to reduce muscle spasm and stimulate healing, ultrasound for deep tissue heating, hydrocollator for moist heat, and cryotherapy (cold therapy) are used with a vari-ety of removable orthopedic appliances aimed to correct the posWon of the condyle, or "ball," of the lower jaw within its socket. In addition, joint mobilization procedures, physical manipulation, and other procedures might be employed. Eighty-four percent of our last 1200 TMD patients who also had tinnitus reported that their ear sounds were "gone" or "almost gone" after treatment. Treatment time and costs vary according to the extent of dysfunction, the simultaneous pres-ence of related problems such as neck injury or thyroid disorders, patient compliance, and the patient's age. Unfortunately, for reasons not yet explained, we have found a decreased success rate for elimination of tinnitus in patients over 60 years of age. Many patients are given only home care instructions at a single visit, while others require an average of 4-6 months of care. Still others require much lengthier treatment and, in a small number of cases, even surgery. Approximately 1% of our patients require TMJ surgery and approximately 3% require radiofrequency ther-moneurolysis - a surgical procedure that uses high frequency electrical energy to modify or eliminate pain impulses from injured structures. This technique in particular offers enormous promise for eliminating pain and tinnitus where other conservative procedures have failed to bring relief. (continued) American TiJmius Association Tinnitus 7bday! June 1999 17 Con1n1unity Health Charities -Public Donations for Tinnitus As a member of the National Voluntary Health Agencies (NVHA), the American Tinnitus Association participated in the Combined Federal Campaign (CFC). During the last 10 years, federal and state employees have given an average of $84, 000 to ATA each year. We are very proud and thankful for their support. (ATA's designation # is 0514.) During the past year, the NVHA has merged with the Combined Health Appeal in order to expand the donor base to include the private sector. The new federation will be known as the "Community Health Charities." Revenue from the CFC hit its peak in 1991 and then dropped off (because of down-sizing in the federal government) - until this year. Donations are again on the rise. TMJ Dysfunction (continued) Wright and Bifano cite a study in which the relationship between tinnitus and TMD therapy resulted in the following: of 267 TMD patients who were evaluated, 101 reported co-existing tinnitus. Ninety-three of those agreed to partici-pate in the study. Of the 93 subjects who were treated for TMD, 52 said that their tinnitus had resolved, 28 reported experiencing significant improvement, and 13 reported minimal or no improvement. No one reported experiencing a worsening of the condition. It's been noted that patients who have tinnitus without any other symptoms are relatively unlikely to experience improvement with treatment of this type. Over the last few decades, we have come a long way in diagnosing and treating TMJ disor-ders and the accompanying symptoms such as tinnitus. No doubt future research will provide greater knowledge regarding the relationship between tinnitus and temporomandibular joint dysfunction and consequently even higher success rates than are available at the present time. II 18 Tinnitus Tbday/ June 1999 American Tinnitus Association Many thanks to all of you who have donated to our association through the CFC. Our thanks, also, to the following volunteers who have repre-sented us at local meetings and health fairs: Charles Abegg, Tracy Armstrong, Jack Berman, Jim Boardman, Gail Brenner, Judy Brivchick, Dhyan Cassie, Pete Clements, Rob Crichton, Charles Gilbert, Buzz Grossberg, Lynn Haddon, Thrry Hamilton, Kathy Harvey, Bill Haskin, Sharon Hepfner, Ben Jacobs, Carrol Jude, Jim Keyes, Marylou Leubbe, Malvina Levy, Stanley Lewis, Don Lovell, Bob Luthmann, Doug Melton, Jack Mundy, Charles Ohlinger, Harvey Pines, Mari Quigley, Shirley and Mort Rosenhaft, Bob Sandlin, Susan Seidel, Megan Vidis, and Milly Walker. Bl ,\, -;y,Community Health Charities WORKING FOR A HEALTHY AMERICA Dr. Ira Klemons' practice is devoted to head and facial pain and temporomandibular joint dysfunc-tions. He is President of the American Board of Head, Neck, and Facial Pain; and Director of The Center for Head and Facial Pain in South Amboy, New Jersey. Additional information can be obtained at www. headaches. com Names of members of the American Academy of Head, Neck, and Facial Pain can be obtained by writing to the Academy at 520 West Pipeline Rd., Hurst, TX 76053. References l. Wright, F., and S. Bifano: Tinnitus improve-ment through TMD therapy, JADA, vol. 128, pp. 1424-9, Oct. 1997. 2. Gelb, H., M. Gelb, and M. Wagner: The rela-tionship of tinnitus to craniocervical mandibu-lar disorders, Journal of Craniomandibular Practice, vol. 15, no. 2, pp. 136-142, April1997. Tinni tusS u pport@Grou ps by Barbara Tabachnick, Client Services Manager How the definition of "self-help group" has changed! What was once only a gathering at a local church or library one night a month now encompasses a 24-hour-a-day, international, computer accessible network of support. The Internet's Worldwide Web has brought thousands of people in touch with thousands of tin-nitus informational Web sites. It has also brought thousands of people in touch with each other. These are people whose tinnitus or other circum-stances have kept them from traveling to self-help groups, or who live where there is no organized group to attend. The number of support doors that have been opened because of Internet chat rooms and newsgroups is phenomenal. It bears mentioning that discussions on the Web are not monitored or edited by any tinnitus authority for accuracy or attitude. One wonders: do they need to be? (I could easily argue both sides of the question!) The bigger question is this: with 10,336 tinnitus-related Internet Web sites to date, who would have time to do it? Tinnitus information on the Internet is a collection of the volunteered thoughts and investi-gations of people who have tinnitus, who have rela-tives troubled by tinnitus, or who treat tinnitus. Active participation is optional: one can contribute information to it or simply read it. In this regard, it displays a close resemblance to the old-fashioned support group, the kind where you enter freely, take what information you want from it, and leave the rest. Jim McGlynn, a tinnitus Internet newsgroup participant recently attended the Los Angeles Tinnitus Support Group's 15th anniversary seminar where Dr. Stephen Nagler spoke. Afterwards, Jim went back to his Internet support group and shared these thoughts: "Stories on the Internet lose a lot in the trans-lation. Many of the things Dr. Nagler said at the conference are things he has published on his Web site. The stories were not new to me. But with inflection, direct interaction, and eye contact, they all seemed different. "The Internet is a wonderful place. Our ques-tions are answered by people around the world. There are things we can write here that help an uncounted number of people. It has its advantages and it has its limitations. I think that it's important to check out a real live support group or tinnitus lecture if you can, to shake the hand of someone else whose ears are also ringing. I'm lucky. I got to sit with people like me at that seminar, people who also have tinnitus. I'm very lucky." What meets your support need? A reassuring telephone call? An empathetic hug? A 4 a.m. on-line chat? E-mail? Real mail? W1ite or call us for details on how to connect with others. We'll be in touch. al ATA, P.O. Box 5, Portland, OR 97207-0005 voice: 800/634-8978 fax: 503/248-0024 e-mail: tinnitus@ata.org Web site: www.ata.org Welcome to ATA's New Support Givers Telephone/Mail Contacts Kathleen Munley 387 Main St. Archbald, PA 18403 717/876-2747 munleyg@microserve.net Alex Ravetti 2314 S.E. 27th 'Thrr. Cape Coral, FL 33904 941/772-8956 B. Martin Brinitzer 18278 Hummingbird Dr. Penn Valley, CA 95946 530/432-3507 Beryl Clark 445 Seaside Ave. Box 164 Honolulu, HI 96815 808/923-8716 Support Group Leaders Elayne Myers 40 Pennyroyal Rd. Malta, NY 12020 518/899-4885 David M. Smith 6501 Byron Ave. Springfield, VA 22510 703/866-3025 Marie Richter, M.S., CCC-A Hear America, Inc. 12352 Olive St. Blvd. St. Louis, MO 63141 314/514-7800 American Tinnius Association Tinnitus 7bday! June 1999 19 My friend T taUght me how much my family loves me. My friend T taught me how wondrous each new day is. My friend T taught me that I had too much stress in my life. My friend T taught me the value of good sleep. My friend T taught me to eat healthy foods and take my vitamins. My friend T taught me how wonderful my Motown collection is. My friend T taught me to take nothing in life for granted. My friend T taught me that it is okay to reach out for help. My friend T taught me that I was abusing my body with loud sounds. My friend T taught me who my real friends are. My m end T taught me that I need to love me. My friend T taught me to appreciate joy. My friend T taught me to control and confront my fears. My friend T taught me that I could change vocations and become MORE successful. My friend T taught me to be a flexible thinker. My friend T taught me to be strong. My friend T taught me not to let the little things in life bother me. My friend T taught me to enjoy the sounds of nat ure. My friend T taught me the power of positive thinking. My friend T is one of the best friends I have ever had ... he just has a really annoying voice and he talks too loud! 20 Tinnitus 7bday/ June 1999 American Tinnitus Association A Special Book Offer New Low Price on Proceedings The Proceedings of the Fifth International Tinnitus Seminar is a treasury of 1 31 tinnitus research papers on topics including: causes and measurement of tinnitus, drug therapies, clinical treatments, tinnitus retraining therapy, psychological approaches and implications, legal and noise issues, self-help strategies, and alternative remedies. The Proceedings is now available at the special low price of $10, plus shipping & handling. To add to this great offer, a limited number of books are signed by editors Gloria E. Reich, Ph.D., and Jack A. Vernon, Ph.D. Please use the form on the inside back cover of this issue to place your order. Advertisement I WISH MY HUSBAND could hear what I hear for just five minutes." Sandy Miller, Norfolk, VA Well Now He Can! "THE WORLD OF CONSTANT NOISE" is an audio presentation hke no ot her avail able. Not just a cataJog of sounds - this tape incorporates the audio world of Tinnitus a n d Hyperacus1s into "My husband looked at me and said, '1s THAT realLJ what you hear?!" Then he hugged me and cried." Nancy 'I)' ler- ._,.....,:-':-'...;;;,;,;,;..;..._J It takes vou through WI avemgd dav from the ahum clocl. to Cti) Hughes. Tampa. FL BONUS Side 2 "Tiumlus The Souudr" audio catalog of the various sounds By the end of the seven mtl'ltHe t.lpe, those without Tmnitu!l. suddenly "know" almost first h3J1d what you'\e been sul1enng through Send $10.00 (plu.s2.95 S&H) to: The Dents St'Otl Foundat1o11 PO Box 162, Iselin, NJ 08830 QUESTIONS AND ANSWERS Jock Vernon's Personal Responses to Questions from our Readers by Jack A. Vernon, Ph.D., Professor Emeritus, Oregon Health Sciences University QMr. S. from Pennsylvania writes to ask about the work of Col. Richard D. Kopke and the Army Medical Corps. An article in the local newspaper indicated that they were working on a way to save inner ear hair cells from toxic or damaging agents. Their procedure involves placing a miniature catheter deep into the ear in order to inject medicine to the exact place it is needed. The approach uses anlioxidant drugs to counteract toxic compounds generated by injury. Dr. Kopke and his team of researchers have demonstrated success with this technique on animals and to date have tried it on three people with apparent success in all three. AI think Dr. Kopke's work is very interesting and very important. Loud noise and drugs such as the aminoglycosides damage the ear by causing the production of harmful substances known as free radicals. That production can be reduced or prevented by the presence of antioxi-dants. It is this antioxidant which Dr. Kopke is injecting into the inner ear. I firmly believe that the delivery of the drug to the exact position where it is needed vvill offer significant advances for noise-induced and drug-induced damage to the ear. [See "Perfusion of the T1mer Ear Via Round Window Membrane," page 9.] It is also very possible that any action that prevents or corrects ototoxicity or ear damage will also prevent or correct tinnitus. Q Ms. S. from Pennsylvania states that she has followed the Xanax dose schedule and has experienced only slight relief from it. What, she asks, should she do next? ASome patients who have gotten only minor relief from 0.5 mg three times a day have found significant tinnitus reliefby increasing the dose to 0.5 mg four times a day. I suggest that you consult your prescribing physician about this possibility. Do not do this without his/her permission. QMs. G. in North Carolina writes to describe an unusual hearing effect. After she is exposed to the sound of a hair dryer and the dryer is turned off, she continues to hear the sound of that motor. She has been unable to find any information about this effect although her doctor told her it was "inner ear tinnitus." She also notes that she has sensorineural hearing loss. AI am not sure there is an answer for your question. I would guess that most likely the retention of the motor noise is occurring somewhere in the area of the brain devoted to hearing. You are not the first person to report the occurrence of sound retention. Several other patients have remarked upon the retention of music after listening to music. Here is my ques-tion for you: does the retention of sound cause you any inconvenience? One wonders if correcting the sensorineural hearing loss with hearing aids would correct the sound retention phenomenon. Also, reducing the level of the motor noise with earplugs might reduce either the intensity or the duration of the sound retention. At least it is something for you to try. QDr. S., a dentist in South Africa, writes that he has had tinnitus for many years and wonders if his exposure to the high-speed drill caused his problem. His ENT physician thinks he might have otosclerosis which might have caused his tinnitus and his sensorineural hearing loss. He wishes to investigate the possible connec-tion between hearing Joss and tinnitus and the use of the dental drill. He asks if there is any literature on this topic. AThe literature with which I am familiar is only that of Dr. G., a dentist and a patient of mine, who surveyed a11 the dentists in Oregon, Washington, Idaho, and Northern California. He found that all who had purchased the high-speed drill, which became available in 1955, had high frequency hearing loss and tinni-tus. 1b prevent your tinnitus from becoming worse, we recommend that you wear ear protec-tion any time you are using the high-speed drill. QMr. K. from Pennsylvania states that he has tinnitus. But because he has normal hear-ing, the Social Security Administration's disability division will not acknowledge the pres-ence of tinnitus. They claim that tinnitus is caused by and must be accompanied by hearing loss. AOregon Hearing Research Center's Tinnitus Clinic has treated over 6,000 patients with significant tinnitus. Ten percent of these patients have normal hearing as determined by actual audiometric testing. I hope this helps your case presentation. (continued) American Tinnius Association Tinnitus Today/ June 1999 21 Questions and Answers (continued) QMs. C. in California asks ifthere are any new products on the market for the control of tinnitus. She has tried Xanax and it did not work for her. In addition she is almost com-pletely deaf so that masking is not a possibility. AMs. C., you might want to investigate the pos.sib.ility of a cochlear implant which in the maJonty of cases not only provides hearing but tinnitus relief as well. The House Clinic in Los Angeles indicates that 90% of their implant patients obtain tinnitus relief. I have also learned that American Pharmed Labs, Inc. in Englewood Cliffs, N.J. (www.apl-pain.com) is considering production of a transdermal or "through-the-skin" product, called "Paintrol TV," for tinnitus and vertigo. Their medical director told us that they are trying to develop a way to deliver a topical anesthetic drug (they wouldn't tell us which one) to relieve tinni-tus. They say they are at least a year away from seeing results. QMr. Z. in California states that his tinnitus is the sound of dripping water which he only hears at night. He found that putting a swimmer's earplug in the affected ear stopped the problem. He asks if it is the pressure of the earplug m the ear canal that stopped the tinnitus. AA guaranteed way to make tinnitus louder is to earplugs, thus your opposite experi-ence IS most unusual. It may be that you are experiencing what is termed "objective tinnitus." That is, the tinnitus you hear is not a phantom sound experience but rather a real sound being gen-erated inside the ear. In some cases of objective tin-nitus, others can hear the sound coming from the patient's ear. I suggest that you locate an audiologist who has an Etymotic Insert Earphone. This device contains a small, sensitive measuring microphone with which to listen to the ear (such systems are used for special tests to evaluate "otoacoustic emis-sions" in the ear) and possibly determine if you have some mechanical problem in your middle ear, such as a perilymphatic leak. If so, it should be possible to provide a patch to repair that leak. QMs. L. in Illinois presents a very interesting and puzzling condition. She states that due to her hyperacusis (a super-sensitivity to everyday sounds), she can only tolerate TV by mut-ing it, then listening to the audio with a small radio capable of receiving the TV channels. She is curi-ous about the fact that the small radio can present the audio at an acceptable level while the TV cannot. 22 Tinnitus 7bday/ June 1999 American Tinnitus Association AHyperacusis is inversely related to the pitch of the sound. That means that the higher the pitch, the less tolerance the person with hyperacusis has for it. Most likely the small radio does not reproduce the high pitches as well as the TV speakers do. Please remember that hyperacusis can be relieved by not overprotecting your ears and by listening to low-level "pink noise" to rein-state your normal loudness tolerance. It is not an easy procedure but it can be beneficial if you stick with it. I would further suggest that you not use any ear protection for sounds that are 65 dB or less for a period of one month. (You can get a sound level meter at Radio Shack for about $35 to mea-sure the sounds in your home and elsewhere.) Then for the next month, do not use ear protection for sounds that are at 70 dB or less and so on until you are at the level of normal loudness tolerance. QMr. H. in West noticed that he cannot hear h1s tmmtus when he is standing near his refrigerator when the motor is running. The refrigerator motor is very low-pitched. Indeed, he thinks he can only feel it and not hear it. He asks whether or not sounds that are either too low-pitched or too high-pitched to be heard might produce a "silent masker." AMany years ago I had a similar idea. 1 rea-soned that if ultrasonic sound (which the human ear cannot hear) could mask tinni-tus, we would have the ideal condition. I tested a number of tinnitus patients first to determine which high-frequency region they could not detect, and then to see if that frequency region could mask their tinnitus. It turned out that if they could not hear the sound, their tinnitus could not be masked. Recently there has been a new twist on this approach. Hearing Innovations, Inc., in Thcson, Arizona (http://hearinginovations.com), has developed the HiSonic device - a high-frequency bone conduc-tion hearing instrument for people who are pro-foundly hearing-impaired. A modified version of the HiSonic was studied at the Oregon Hearing Research Center's Tinnitus Clinic to see if it could be used as a super-high-frequency tinnitus masker. This modified device generates frequencies up to 36,000 Hz which is way beyond what we should be able to hear. Of the 20 tinnitus patients tested, 90% experienced some degree of masking, and 85% of them had residual inhibition - a cessation of the tinnitus after the masker is removed - of slightly longer duration (although just minutes longer in Questions and Answers (continued) most cases) than that induced by conventional maskers. We don't know exactly what the HiSonic is stimulating since most of the profoundly deaf people who can hear with it probably have few if any cochlear hair cells. Q Mr. H. from North Dakota writes to say that he is aware that the sound of front air bags inflating is too loud for the human ear. What, he asks, is the level of the sound produced when side air bags are added? And shouldn't we have the optjon of h1ming them off? AThe addition of side air bags to two front air bags can cause the noise inside a car to reach 178 dB. However short the exposure, that is too loud for the human ear! Keep in mind that a 140 dB sound is right at the human thresh-old for pain. There have been concerted efforts to get air bag "on-off switches" installed or to get the air bags disconnected altogether. So far, most of these efforts have failed. (I have heard that air bag manufacturers have a very powerful lobby in Washington, D.C.) I think the idea of a switch is very reasonable so that air bags could be turned off or on at the drivers' discretion - off when driving in town where accidents might not be life-threatening, and on when driving on freeways. I have reports from two patients who sustained h earing loss and tinnitus from very minor, very low-speed accidents in which air bags inflated. Remember that regardless of where you drive, use of the seat belt is mandatory. Notice: Many of you have left messages requesting that I phone you. I simply cannot afford to meet those requests. Please feel free to call me on any Wednesday, 9.30 a.m. - noon and 1:30 - 4:30p.m. PDT (5031494-2187). Or mail your questions to: Dr. Vernon c/o Tinnitus Thday, American Tinnitus Association, PO. Box 5, Portland, OR 97207-0005. Advertisement Now, masking Tinnitus won't keep either of you awake. Tired of Tinnitus keeping you awake? Is masking keeping your spouse awake? Finally, heres the product that will help you both sleep--THE SOUND PILLOW. let two wafer-thin micro-stereo speakers nestled within a plush full-size pillow ease your Tinnitus troubles today. With a speaker jock that fits most radios, cd players, and televisions, the Sound Pillow delivers the soothing masking sounds you need (and your partner will really like this) without disturbing others. Finally, a sound device that allows you to comfortably and offordably mask tinnitus. Call and order your Sound Pillow today so both of you con sleep better tonight. www.sou ndpillow.com $39.95 (for A.T.A. members) $49. 95 regular price TOLL FREE (877) TINNITUS (846-6488) American Tinnius Association Tinnitus Thday/ June 1999 23 SPECIAL DONORS AND TRIBUTES ATA's Champions of Silence are a remarkable group of donors who have demonstrated their commitment in the fight against tinnitus by mak-ing a contribution or research donation of $500 or more. Sponsors and Professional Sponsors have con-tributed at the $100-$499level. Research Donors have made research-restricted contributions in any amount up to $499. Contributions to ATA's 'Ih.bute Fund will be used to fund tinnitus research and other ATA pro-grams. If you would like your contribution restrict-ed for research, please indicate it with your gift. Thbute contributions are promptly acknowledged with an appropriate card to the honoree or family of the honoree. The gift amount is never disclosed. Our heartfelt thanks to all of these special donors. All contributions to the American Tinnitus Association are tax-deductible. GIFTS FROM 1-16-99 to 4-15-99. Champions of W.E. Couling Romulus z. Linney Patricia A. and Richard Ronald L. Steenerson, Deborah J. Frye, M.A. Silence Kay F. Crouse John w. Mars Smith M.D. Jeanne B. Gaylord (Contributions of $500 Elizabeth J . Curtis Tim Matheson Raymond M. Smith, Ill Steven Stegman Stephen P. Gazzera John G. Davis Dr. Curtis L. Mathis, Jr. Lewis E. Stengel, ,Jr. John C. Vaughan, M.D. Barry S. Goldberg and above) Walter Z. Davis, ,Jr. Mike and Bonnie Leonard Stowe J. Dan Weathers, M.D. Susan E. Griest, MPH Roy Barna Joaquin Delpino McCann Michael M. Sullivan Edmund .J. Grossberg. Robert w . .Booth Gilles C. Desbiens Eugene McFaddin Richard W. Sullivan Corporations with CLU Carol A. Brown Lewis G. Desch Colin L. McMaster Ruth M. Swan Matching Gifts Richard R. Harlow Charles T. Brown Anita E. Dever Juerg Meng Max and Jean American Express John T. Hennig Thomas w. Buchholtz, Jerome C. Dougherty 'Thrrill E. Menzel Thnnenbaum Argonaut Group Virginia R. Holt M.D. Hugh W. Emerson, J r. F. N. Merralls Irwin Thntleff Bank America W.F. Samuel Hopmeier, Mary Kay H. Davis Francis R. Fant, Jr. Andrew Metrick Daniel K. Thrkington Foundation BCHfS Frank H. Dunn Kathryn. Alexander Miller David Hollis Thylor Bestfoods North Darrell and Bette Jean and Lou Fockele Fitzsimmons Eugene A. Miller Scott 11.1 mer America Johnson Helen Pappas Janet E. F1orentin Robert E. Monaghan Brian VanPutten BP America, lnc. Gregg L. Johnson Louise Parmley Mary A. .Floyd Earl R. Moore Robert J. Veltkamp Citicorp Foundation Neal and Joyce Stephen G. Sayegh Martin E. Fossler Jeff Morse William P. Voerg Computer Assoc. Johnson Stephen M. Schwarcz, Duane Foster Andrew J. Murphy A. Gary Voyten Inti., Inc. Scott L. Johnson D.D.S. Isaac Frishman Cameron R. Murray Eliot Wagner J.P. Morgan & Co., Inc. Beth Kempton Phyllis W. 1\viss Michael J. Fucilli Margaret Nau Linda A. Wainhouse Johnson & Johnson Dr. and Mrs. Paul Kline Daniel H. Walker Veva J . Gibbard Glenna L. Neilsen Bernard J. Weber Mobil Peter Kobelansky Stephane W. Wratten Nathan L. Gibson Dr Vernon&lisabeth Edward R. Weiss Pfizer Inc. Warren L. And Virginia Delbert W. Yocam Charles W. Gilbert Neppe Dehner D. Weisz Phil ip Morris M. Lagers Sponsors James S. Gold Frank P. Nicoletti AlE. Witten Sarah Lee Foundation Rose Marie and Loran (Individual Contributions Donna Graham Thomas R. Ogren Brian and Karen Sun Microsystems Lathrop from $100. $499) Paul Green R. J. Palornbit Woolsey 1\"ansamerica Howard Levirne Gerald w. Ape! John P. Griesbach Randy L. Parks Walter K. Wornick Foundation Barbara Lighthizer Robert A. Bailenson Jane A. Robert E. Parr Mr. and Mrs. David J. Safeco Insurance Jill Lilly John J. Banavige Donald D. Gu1t0 Thomas J. Patrician Wright Union Pacific Mike and Georgina James R. Barney Faye M. Harrison Kenneth W. Pearce Paul W. Zerbst Resources PAC Linghor M. Lloyd Baum Diana G. Haver Adelio Percic Brad Zennan US West Frank L. Long Peter B. Baylinson James R. Heard Peter Phair Marilyn K. Zion Washington Mutual Vince Loporchio Howard G. Bernett Glen Heidbecht Kim Pollock Professional Special Friends Robert E. Lyons Dan G. Best Mark Herritz Richard E. Popovits, Jr. Vince Majerus Judy C. Bezek Paul G. Hill Margaret L. Possert Sponsors Fund Mary A. Marshall Gordon J . Birgbauer, Jr. Gulielma T. Hooper Daniel Pritchett (Professional In Memory of Dr. Lynn and Sharon R. John Bishopp Daniel E. Horgan Jessie N. Quinn Contributions from Robert M. Johnson Martin Bob Boggus Andrew Hrivnak, 1IJ Martha Ramos $100-$499) Charles w. Abegg, Sr. William Hal Martin, Michael L. Bowen Anita Jane Hull Catherine S. Reitz Robert Battista, M.D. Richard and Susan Ph.D. Sharon E. Bowyer Karen Hunt Carl F. Rench Gail B. Brenner, M.A. , Ahlquist Raymond and Rebecca Robert J. Bradley Robert C. Jncerti Patrick R. Richards CCC-A Alan and Carol Baker Mathsen Dorothy M. Brahm Philip H. Ingber Herbert Roach Joseph Danto, Ph.D. Miriam G. Bloomfield John P. And Jenny A. Alan L. Brock James Irving Philip L. Robi nson Barbara Goldstein, Laird C. Brodie Merkel Robert L. Brown, Jr. Elizabeth A. Ivankovic Anna S. Roemer Ph.D. B. Evelyn Brown Keith R. and Susan L. Helen S. Burkey Wayne G. Jakobs Linda Ronaldson David W. Holmes, Richard E. Burnham Morgan Richard A. Burns Eric Janie Beth and Scott Ross Ph.D. Kristen Carlisle Julie Morin J. Christopher Carson Hartmut G. H. Jaspert Jon M. Rundle Pat Johnston Carol J. Carpenter Gary Morton Charles A. Carver Kurt Jensen M. Vem Rupp Jeffrey S. Keyser, M.D. Jack D. Clemis, M.D. Stew and Kay Morton Merle C. Chambers Nils P. Jensen John and Jrma Russell Gregory D. King, M.S., Donald J . Cook Stephen M. Nagler, Kerry N. Chatham, Oscar S. Johnson, III Frederick J . Ryan CCC-A Rose Cottrell M.D., F.A.C.S. DVM Kenneth W. Jones Russell A. Sabanek Guy E. McFarland, Richard . And Eileen Dallas and Louise ShuN. Chau Louis 1. Jones Stewart Sandman M.D. E. Cronn Nelson Gail Chesler Pawzi Kawash James B. Sasser Aage R. M0ller, Ph.D. Ralph J. D'Ambrosio, Bruce and Karolyn C. J. Childers Alexandra B. Keith Marie Saxe John D. Mowry, M.D. Jr. Newgard Clary Childers 0. Ray Kirkpatrick Evelyn J . Schwenl Scott M. Nelson, M.D. Jackie DeGagnc Mr. and Mrs. Francis D. Ralph G. Ciaramello Norma Kratz Robert R. Sfi re D.W. Newton, D.D.S. M. Bernice Dinner Nold Garrett H. Clark Jerry Lastelick Mark Shaffstall William Lee Parker, Virginia M. DuBlanc Jerry L. Northern, John F. Coggin Shirley C. Lavenberg Robert J . Shapiro Ph.D. Sylvia Eisenberg Ph.D. Gardner C. Cole Stewart M. Ledbetter Fr. Thomas F. Sheehan, Tra D. Rothfeld, M.D. John R. Emmett, M.D. Alfred Nuttall , Ph. D. Stanton Cole Barbara S. Lentz OFM Jeffrey R. Schlesinger Alfreda R. Fedrizzi Elizabeth K. O'Halloran Robert L. Coley Laura Leprino Glenda Sheppard Abraham Shulman, Jean and Lou Fockele Kathy Peck Diana C. Connolly Hazel Lessley 'Thrry Blair Sidwell MD. Herbert Frank Leslie Petcher Joseph A. Cordes Roben Link Rube Simon Jnge Frederiksen Nicholas J. Pialoglous 24 Tinnitus 7bday/June 1999 American 'Tinnitus Association SPECIAL DONORS AND TRIBUTES (continued) Lynn 1<. Pratt Daria Laird In Honor Of Jane E. Darlington Andrew J. Leginze Elsie R. Simas Edward Porsov Gloria Mante Dl'. Alan Loclwood Almudena De Llaguno Raymond J. Lemoine Robert C. Sittig Penny Roberts Rap10r William Marlette Stephen M. Nagler, Marilyn C. Dee John E. Lewison Thelma M. Sjostrom Fredric D. And Barbara Susan McCloud M.D., F.A.C.S. Aldo Delco! Jorene M. Lightfoot Betty J. Slater Y. Reed Nirmal Mittal Dr. Billy Martin Vivia M. Dennis Donald J. Lisio Clyde and Darleen Gloria E. Reich, Ph.D. Ruby Morek Stephen M. Nagler, Rita M. Desotell Richard P. Loach Smi[h Tianying Ren Hiep Nguyen M.D., F.A.C.S. O'Neil N. Destefano Palmer R. Long David R. Smith Paul Richter, M.D. James O'keefe Philip 0. Morton Jules H. Drucker John M. Maiorano Kenneth J. Smithee James A. Rocthlin Lisa Pierce Lake Grove Dorothy M. Earl V. James Marino Paul C. Sorensen Herman J. Schechter Jim Politi Presbyterian Church Linda D. Elliott Carol A. Markey Larry A. Stafford, SFC Alexander J. Jeff On Or. Richard Salvi Harvey A. Erikson Alexander Markowski Henry G. Stanley Schleuning, M.D. Brenda Proctor Stephen M. Nagler, Michele Ezratty Gilbert D. McCann Lewis E. Stengel, Jr. Susan J. Seidel, M.A., Karen Rockey M.D., FA.C.S. Edgar M. Feathers Richard E. McCollum David B. Stewart CCC A Steve Russell Jack A. Vernon, Edward A. Feldkamp Kenneth J. McGinnis Ruth N. Stewart Madge Sempert Kim Scullen Ph.D. Robert J. Fendrich Roberta J. McKenna Ingrid H. Stroud Robert E. Shields Monica Seh Patrick Guyton August E. Firgau Mary Beth McMahon John A. Sullivan Florence A. Smith Evelyn Sinkler Bernard Fishman Edward J. Megerian W. Pat Sullivan Peter F. Smith James Smith Research Donors Johnston K. Fite Carolyn V. Merritt Ruth M. Swan Stellajoe E. Staebler Eleanor Stone Helen D. Adams Larry C. Focht Rhoda S. Mesker Irwin 'Thntleff Elizabeth Stevenson Wanda Thoclle Ken Adler Linda and Nelson Fox Gary Mi[Chell Abraham 'Thubman Elizabeth S. Thylor JaneS. C.'trnaltan Joseph w. Adside, Robert M. f'uller, Jr. Janet Mitchell Willard C. Thorn Harvey and Elizabeth Jamee Wolf Ph.D. William M. Gabriel, Sr. Barbara W Moose Barbara and Richard Thompson Dr. Trudy Drucker Marian H. Agee Grace E. Gaereminck Rebecca Morrison 1l"attner Brian and Jennifer Thlk Adele Alam Lloyd T. Amaral Nick Georgeoff Jeff Morse Barbara 'Il'oy James and Ann Ulum Jules H. Drucker Rae Azose Gigi Giannoni Edward Muserlian Florence 'Thukui Jack A. Vernon, Ph.D. Mora Emin Natalie E. Babson Thomas C. Glassie John and Louise Myers Bettie M. 1hcker Joan and David Vick C1therine M. Bailey James J. Gleeson Donald . Nace J\llarilyn Turville Kenneth and Ruth Vick Bob !-locks Joan U. Ball Frances M. Goldbourne Ian L. Natkin Christine E. Ulanowski Fred H. Wilken (1n memory of Renee R. Ballou Bob Goodman Dean B. Nelson Jack Wallner Donald and Jody brother's birthday) E. Louise Barg Theresa Gray Douglas Nord Delmer D. Weisz Witten Joanne Jeremiah Irma A. Barrett Seymour Greenblatt Keith and Stacy Oliver John and Sherri Wright NelJie Jackson Janet E. Baumgartner Jack I. Groom Michael F. Otero Christine Yoshinaga Katherine S. Wootton Jay C. Bear Gerald L. Gulseth JohnS. Ott ltano Norman Jesfjeld Prof. Erol Belgin, Ph.D. francis S. Hall Leonard J. Pacifico Diane and Lester Zoller Arlo and Phyllis Nash Paul R. Bennett John E. Hall David Palmer TRIBUTES Kermit Johnson L.E. Bentkowski Richard E. Haney Joan Parker Bernie Bercuson Margaret A. Harrod Thomas J. Patrician In Memory Of Arlo and Phyllis Nash Helga R. Bergthold Harold J. Henderson Jeffrey Pauker Lillian Pauline Howard G. Bernett Victor Hierl Roi N. Peers Jane Burkard Markowitz Jeanne B. Betcher Judith S. High Mr. and Mrs. Donald R. Bernard Kinter John Biviano Lena Bernstein Mark A. Bleich Linda Hoeger Perry Edna and Nathan Kim D. Blume George Homa, Jr. Lucille M. Petersen Fabrice Bonnaire Douglas Brennan Chansky Diana Boatwright Shirley J. Hostetter Craig S. Phinney Linda and Nelson Fox Jay M. Borick Ann M. Hotta Rita Hundt Pincsak Gopa Chakrabarti Ethel Gordon Gene Borok Herbert R. Hughes Richard E. Popovi[S, Jr. Thomas Cordes Marion C. Lappin Dr. Lowell L. Bouchard William H. Hunnicutt Col. Richard L. Prave Thomas Davis Herbert Mann Eleanor P. Boyle Patricia A. Ilardi R. Steven Pulvennan, Lamine Diallo Doris Edwards Amy Fish Siegel Loran J. Brader James Irving DO. Mark Edwards Franz Miles Dennis D. Braun Susan M. James Thomas J. Rabideau Edv.,in Espejo Arlo and Phyllis Nash Barbara F. Brown Donald J. Janov Laura L. Ragonese Leola Farmer Helen Pagel Julian Bulla Joanne Jeremiah Rose M. Rainona Mary Ellen F'eid Arlo and Phyllis Nash John J. Burke David T. Kaczmarek Jack M. Rauch William Foster Rose (lllother of Michael W. Burnham George K. Kanemoto Robert Ravoni Angela Green Millicent Weiser) Edward P Canto Larry W. Karkela James M. Reel Stuart B. Carlson Henry B. Keese Thomas M. Robertson Terry Hairston Jerome Kurtz Ralph Carn1en R. L. Keheley Alden R. Rodgers Pooran Hamidi David Schwartz David Hannaford John A Champlin Harry G. and Marion Albert and Eileen Eldridge Harding Claire and Jacques La'\l'Tence Chance Keiper Roemer Simon Carol Jean Chatterton Frank L. Kellogg, Jr. Richard Rohrmann Joyce Hicks Joyce Sinatra Patsy Cilurzo William J. Kerschner J. Lewis Romett, M.D. Sharron Hicks Thomas Hicks Claire and Jacques Luella Clausen Shirley M. Kimel Mary Rothman Jacqueline Holder Simon Ralph Consiglio Gerald F. Kiplinger Albert Rouse An Huynh Phil White Maryanne Cornelius Kenneth P. Kleinpeter Bunny J. Safron Gregory Issac Don and Dolly Mozel Harry H. Cotterill, Jr. David R. Kosutic Dustin Schaller Scott Johnson Edna Wootton W. E. Couling Sue Kozlowski Emily A. Serko Diane Katz Mr. and Mrs. Axel Dennis M. Cox Lance Kroetz Margaret B. Shattles Paul Krasley Anderson Carolyn Jean Marie E. Kruse Norma T. Sheld Olga Armstrong Cummings Joseph A. Kuhn Glenda Sheppard M. Ann Hutton Dennis M. Daly Mildred A. Kunkel William P. Sherman William J. Wolfe Eileen M. Dambis Jeannette Lawrence Dorothy L. Shipe American Tinnius Association Tinnitus 'TI>day/ June 1999 25 You m_ight have noticed ... an error in our 1999 calendar (in the December 1998 issue of Tinnitus Thday). Please accept our apologies - and our new corrected calendar. American Tinnitus Association Working throughout the year t o s i le n ce ti nnit us 1999 January February March April SM TW T SSM T W TFSSMTW TFS SMTW S l 2 l 23 456 1 23 456 23 3456 89 8 9 10 11 12 13 8 9 10 11 12 13 4 5 6 8 9 10 10 11 12 13 14 15 16 14 15 16 17 18 19 20 14 15 16 17 18 19 20 11 12 13 14 15 16 17 17 18 19 20 21 22 23 21 22 23 24 25 26 27 21 22 23 24 25 26 27 18 19 20 21 22 23 24 24 25 26 27 28 29 30 28 28 29 30 31 25 26 27 28 29 30 31